Nokea
The process of labor places significant metabolic demands on the obstetric patient. Which physiologic findings would be expected?
- A. Decreased maternal blood pressure as a result of stimulation of alpha receptors
- B. Uterine vasoconstriction as a result of stimulation of beta receptors
- C. Increased maternal demand for oxygen
- D. Increased blood flow to placenta because of catecholamine release
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Labor is a physically demanding process that requires increased energy expenditure.
2. Increased uterine activity during labor leads to higher oxygen consumption by the mother.
3. Maternal demand for oxygen increases to meet the metabolic needs of both the mother and the fetus.
4. Adequate oxygen supply is crucial to support the increased workload during labor.
Summary:
A: Incorrect. Labor typically leads to increased blood pressure due to sympathetic activation, not decreased.
B: Incorrect. Uterine vasoconstriction is not expected during labor as it needs adequate blood supply for contractions.
D: Incorrect. Catecholamine release during labor can lead to vasoconstriction, not increased blood flow to the placenta.
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While assisting with a vacuum extraction birth, which alteration should the nurse immediately report to the obstetric provider?
- A. Maternal pulse rate of 100 bpm
- B. Maternal blood pressure of 120/70 mm Hg
- C. Persistent fetal bradycardia below 100 bpm
- D. Decreased intensity of uterine contractions
Correct Answer: C
Rationale: The correct answer is C: Persistent fetal bradycardia below 100 bpm. This is crucial because it indicates fetal distress and requires immediate intervention to prevent potential harm to the baby. Bradycardia below 100 bpm may indicate inadequate oxygen supply to the fetus, necessitating urgent action. Maternal vital signs in choices A and B are within normal ranges. Choice D, decreased intensity of uterine contractions, while important, is not as critical as fetal bradycardia in this scenario.
Which aspect of newborn assessment may be limited by the application of a vacuum extractor at birth?
- A. Anterior fontanel
- B. Coronal suture lines
- C. Posterior fontanel
- D. Biparietal diameter
Correct Answer: C
Rationale: The correct answer is C: Posterior fontanel. When a vacuum extractor is used during birth, it can cause swelling or molding of the baby's head, which may affect the assessment of the posterior fontanel. This fontanel is an important landmark for determining head size and shape. Swelling or molding can make it difficult to accurately assess the fontanel's size and shape, potentially impacting the overall assessment of the newborn's head.
A: The anterior fontanel is not typically affected by the use of a vacuum extractor.
B: The coronal suture lines are not directly impacted by the vacuum extractor.
D: The biparietal diameter can still be measured accurately even with molding caused by the vacuum extractor.
A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely apprehensive because this is her first childbirth experience and asks for an epidural to be administered now. What is the priority nursing response based on this patient assessment?
- A. Use contact anesthesia for an epidural and prepare the patient per protocol.
- B. Tell the patient that she will not need any pain medication because the birth will be over in a matter of minutes and the pain will stop.
- C. Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth.
- D. Call the physician for admitting orders.
Correct Answer: C
Rationale: The correct answer is C. In this scenario, the patient is fully dilated and at +2 station, indicating imminent birth. The priority nursing response should focus on assisting the patient with nonpharmacologic pain distraction methods as the birth is likely to occur soon. Nonpharmacologic pain management techniques such as breathing exercises, positioning changes, massage, and emotional support can help alleviate the patient's anxiety and provide comfort during this intense stage of labor. Administering an epidural at this late stage may not be feasible or effective due to the advanced stage of labor and imminent birth. Options A and D are not appropriate as they do not address the immediate needs of the patient in active labor. Option B is incorrect as it dismisses the patient's request for pain relief and fails to address her emotional and physical needs during labor.
Which comfort measure should the nurse utilize in order to enable a laboring woman to relax?
- A. Recommend frequent position changes.
- B. Palpate her filling bladder every 15 minutes.
- C. Offer warm wet cloths toN useR on Ithe GpatiBen.t'Cs faMce and neck. U S N T O
- D. Keep the room lights lit so the patient and her coach can see everything.
Correct Answer: C
Rationale: The correct answer is C because offering warm wet cloths to place on the patient's face and neck can help promote relaxation by providing a soothing sensation. This measure can help to reduce stress and tension, creating a calming environment for the laboring woman.
A: Recommending frequent position changes can help with labor progress and comfort, but it may not specifically address relaxation.
B: Palpating the filling bladder every 15 minutes is important for monitoring urinary output, but it is not a direct comfort measure for relaxation.
D: Keeping the room lights lit may be necessary for visibility, but bright lights can be distracting and may hinder relaxation.
Which physiologic effect may occur in the presence of increased maternal pain perception during labor?
- A. Increase in uterine contractions in response to catecholamine secretion
- B. Decrease in blood pressure in response to alpha receptors
- C. Decreased perfusion to the placenta in response to catecholamine secretion
- D. Increased uterine blood flow, causing increase in maternal blood pressure
Correct Answer: C
Rationale: The correct answer is C. Increased maternal pain perception during labor can lead to decreased perfusion to the placenta due to catecholamine secretion. When a mother experiences pain, stress hormones like catecholamines are released, causing vasoconstriction of blood vessels, including those supplying the placenta. This vasoconstriction reduces blood flow to the placenta, potentially compromising fetal oxygenation and nutrient delivery.
Choice A is incorrect because increased catecholamine secretion would not directly cause an increase in uterine contractions. Choice B is incorrect because alpha receptors are not typically involved in decreasing blood pressure in response to pain perception. Choice D is incorrect because increased uterine blood flow would not cause an increase in maternal blood pressure; in fact, it would likely have the opposite effect as increased blood flow typically leads to decreased blood pressure.